血清IFN-γ、IL-1β、ESR水平对类风湿关节炎预后的预测价值

Predictive Value of Serum IFN-γ,IL-1β,ESR Levels for Prognosis of Rheumatoid Arthritis

目的探究血清γ干扰素(IFN-γ)、白细胞介素(IL)-1β、红细胞沉降率(ESR)水平对类风湿关节炎(RA)预后的预测价值。方法选择2019年8月至2022年8月在天津中医药大学第一附属医院就诊的167例RA患者作为研究对象,入院后均接受中西医规范治疗,检测比较治疗前后RA患者血清IFN-γ、IL-1β、ESR水平,并根据临床治疗30 d疾病转归情况分为预后良好组和预后不良组,采用多因素Logistic回归分析探究血清IFN-γ、IL-1β、ESR与RA预后的关系,绘制受试者工作特征曲线(ROC曲线)分析血清IFN-γ、IL-1β、ESR水平对RA预后的预测价值。结果治疗30 d后,167例RA患者中有108例患者预后良好,59例患者预后不良。治疗后,RA患者血清IFN-γ、IL-1β、ESR水平均低于治疗前[(27±3)ng/L比(39±6)ng/L,(105±4)ng/L比(159±21)ng/L,13(5,17)mm/1 h比65(60,72)mm/1 h](P<0.01)。预后不良组年龄、简式疼痛问卷表评分、28个关节疾病活动度评分系统评分、血清类风湿因子、趋化素、IL-6、肿瘤坏死因子-α(TNF-α)、C反应蛋白、白细胞计数、血小板计数、血尿酸、基质金属蛋白酶(MMP)-3、MMP-9、IL-17、Toll样受体4阳性率、IFN-γ、IL-1β、ESR高于预后良好组(P<0.01),吸烟史占比、血清调节性T细胞水平、IL-4低于预后良好组(P<0.01),晨僵时间长于预后良好组(P<0.01)。多因素逐步Logistic回归分析结果显示,高IFN-γ、IL-1β、ESR、趋化素、TNF-α水平是影响RA患者预后不良的危险因素(OR=3.865,95%CI 1.211~6.519;OR=3.796,95%CI 1.174~6.418;OR=3.747,95%CI 1.034~6.460;OR=3.543,95%CI 1.241~5.845;OR=3.384,95%CI 1.116~5.652)(P<0.01)。血清IFN-γ、IL-1β、ESR指标联合检测预测RA患者预后的灵敏度、特异度、AUC分别为81.36%、82.41%、0.869,高于血清IFN-γ、IL-1β、ESR单独检测。结论IFN-γ、IL-1β、ESR在RA患者血清中呈高表达,可作为预测RA疗效预后的有效指标,且联合检测预测价值更高。

Objective To investigate the predictive value of serum levels of interferon-γ(IFN-γ),interleukin(IL)-1βand erythrocyte sedimentation rate(ESR)for prognosis of rheumatoid arthritis(RA).Methods A total of 167 RA patients treated in the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from Aug.2019 to Aug.2022 were included.The eerum IFN-γ,IL-1βand ESR levels before and after treatment were tested and compared,and according to prognosis after 30 d of clinical treatment,the patients were divided into a good prognosis group and a poor prognosis group.Multivariate Logistic regression analysis was used to explore the relationship between serum IFN-γ,IL-1β,ESR and the prognosis of RA.Receiver operating characteristic(ROC)curve was drawn to analyze the prognostic value of serum IFN-γ,IL-1βand ESR expression levels in RA.Results After 30 d of treatment,108 out of 167 RA patients had good prognosis and 59 patients had poor prognosis.After treatment,the serum levels of IFN-γ,IL-1β,and ESR in the RA patients were all lower than before treatment[(27±3)ng/L vs(39±6)ng/L,(105±4)ng/L vs(159±21)ng/L,13(5,17)mm/1 h vs 65(60,72)mm/1 h](P<0.01).Age,simple pain questionnaire,disease activity score in 28 joints,serum rheumatoid factor,chemotin,IL-6,tumor necrosis factor-α(TNF-α),C reactive protein,white cell count,platelet count,blood uric acid,matrix metalloproteinase(MMP)-3,MMP-9,IL-17,Toll-like receptor 4 positive rate,IFN-γ,IL-1β,ESR of the poor prognosis group were higher those of the good prognosis group(P<0.01),the proportion of smoking history,serum regulatory T cell level,and IL-4 were lower than those of the good prognosis group(P<0.01),morning stiffness time was longer than that of the good prognosis group(P<0.01).The results of multivariate stepwise Logistic regression analysis showed that high IFN-γ,IL-1β,ESR,chemotin,and TNF-αlevels were risk factors for poor prognosis in RA patients(OR=3.865,95%CI 1.211-6.519;OR=3.796,95%CI 1.174-6.418;OR=3.747,95%CI 1.034-6.460;OR=3.543,95%CI 1.241-5.845;OR=3.384,95%CI 1.116-5.652)(P<0.01).The sensitivity,specificity,and AUC of serum IFN-γ,IL-1β,and ESR indicators combined to predict the prognosis of RA patients were 81.36%,82.41%,and 0.869,respectively,which were higher than serum IFN-γ,IL-1β,and ESR alone.Conclusion IFN-γ,IL-1βand ESR are highly expressed in the serum of RA patients,and can be used as significant and effective indicators to predict the prognosis of RA efficacy,and the combined detection has higher predictive value.